Provider Demographics
NPI:1346740933
Name:NESTER, LAURETTA (PA)
Entity Type:Individual
Prefix:
First Name:LAURETTA
Middle Name:
Last Name:NESTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HARDY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-2314
Mailing Address - Country:US
Mailing Address - Phone:678-588-1478
Mailing Address - Fax:
Practice Address - Street 1:330 HARDY RD
Practice Address - Street 2:
Practice Address - City:BROOKS
Practice Address - State:GA
Practice Address - Zip Code:30205-2314
Practice Address - Country:US
Practice Address - Phone:678-588-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant